發(fā)布時(shí)間：2018-08-10 22:22

【摘要】：目的:本研究旨在分析飛秒激光小切口角膜基質(zhì)透鏡取出術(shù)(small incision lenticule extraction,SMILE)與飛秒激光輔助下的準(zhǔn)分子激光角膜原位磨鑲術(shù)(femtosecond laser assisted in situ keratomileusis,FS-LASIK)后不同區(qū)域角膜厚度短期變化及其與屈光度的關(guān)系;探討SMILE術(shù)后長(zhǎng)期不同區(qū)域角膜厚度的變化特點(diǎn)和臨床結(jié)果及其影響因素,并綜合分析屈光手術(shù)近期和遠(yuǎn)期角膜恢復(fù)的影響因素。方法:回顧性研究。本研究共納入2014年6月至2015年1月在天津市眼科醫(yī)院,行角膜屈光手術(shù)患者86例(148眼),其中SMILE組60例(104眼),FS-LASIK組26例(42眼),分別于術(shù)前、術(shù)后1天、1周、1個(gè)月、3個(gè)月和6個(gè)月測(cè)量角膜最薄點(diǎn)、中心區(qū)(直徑2mm范圍)、內(nèi)環(huán)區(qū)(直徑2-5mm范圍)和外環(huán)區(qū)(直徑5-6mm范圍)角膜厚度,以研究?jī)煞N手術(shù)術(shù)后不同區(qū)域角膜厚度的分布特點(diǎn);另選取自2011年8月至2012年3月于天津市眼科醫(yī)院屈光手術(shù)中心行SMILE手術(shù)治療近視及散光的患者8例(16眼),分別測(cè)量術(shù)前、術(shù)后1天、1周、1個(gè)月、3個(gè)月、6個(gè)月和5年時(shí)角膜最薄點(diǎn)(0mm)以及以最薄點(diǎn)為頂點(diǎn)在周圍直徑2mm、4mm、6mm、8mm處4個(gè)同心圓將角膜分成直徑2mm、2-4mm、4-6mm、6-8mm、8-10mm區(qū)域5個(gè)區(qū)域角膜厚度。以術(shù)前最薄點(diǎn)角膜厚度-術(shù)中切除透鏡厚度=角膜理論厚度,以最薄點(diǎn)角膜厚度-角膜理論厚度=角膜厚度偏差量(△′CT),以術(shù)后不同時(shí)間本區(qū)域角膜厚度-術(shù)后1天時(shí)相同區(qū)域角膜厚度=該時(shí)刻本區(qū)域角膜厚度變化量(△CT)。統(tǒng)計(jì)學(xué)方法SMILE和FS-LASIK兩組間角膜厚度、等效球鏡度(spherical equivalent,SE)、最佳矯正視力(best corrected visual acuity,BCVA)比較采用重復(fù)度量?jī)梢蛩胤讲罘治?組內(nèi)比較應(yīng)用重復(fù)度量單因素方差分析,不同參數(shù)間的相關(guān)性用Pearson或Spearman直線相關(guān)分析。P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、SMILE和FS-LASIK術(shù)后角膜厚度均變薄,兩組術(shù)后1周較1天時(shí)3個(gè)區(qū)域角膜厚度均變薄(SMILE:p≤0.002;FS-LASIK:p0.001),且FS-LASIK組幅度更大(p0.001)。3個(gè)月較1個(gè)月時(shí)均增厚(SMILE:p0.001;FS-LASIK:p0.001)。2、6個(gè)月時(shí),SMILE 3個(gè)區(qū)域均與3月時(shí)無(wú)差別(p0.05),FS-LASIK內(nèi)環(huán)區(qū)與3個(gè)月時(shí)無(wú)差別(p0.05),中心區(qū)和外環(huán)區(qū),外環(huán)區(qū)線性增加,變化有統(tǒng)計(jì)學(xué)意義(p=0.023,0.001)。3、術(shù)后1天、1周、1個(gè)月、3個(gè)月和6個(gè)月,角膜厚度偏差量SMILE組分別為20.06±6.75μm、15.42±6.84μm、17.21±8.02μm、24.42±8.68μm、24.81±8.64μm;FS-LASIK組為-1.57±13.61μm、-14.88±7.46μm、-12.90±8.74μm、-5.52±7.91μm、-3.30±6.80μm,差異有統(tǒng)計(jì)學(xué)意義(F分組=475.150,p0.001;F時(shí)間=113.313,p0.001;F交叉=13.873,p0.001)。4、SMILE和FS-LASIK中心區(qū)△CT均與術(shù)前SE相關(guān)(p0.05),SMILE和FS-LASIK術(shù)后△CT與年齡、術(shù)前角膜厚度、術(shù)后等效球鏡度(△SE)無(wú)相關(guān)(p0.05)。5、SMILE術(shù)后5年時(shí),角膜最薄點(diǎn)、直徑2mm、4mm、6mm、8mm、10mm區(qū)域的厚度分別比6個(gè)月時(shí)增厚了7.56μm、7.69μm、8.50μm、7.88μm、6.25μm、20.53μm,變化均有統(tǒng)計(jì)學(xué)意義(p≤0.030)。6、SMILE術(shù)后5年時(shí),等效球鏡度、裸眼視力、最佳矯正視力分別為-0.1016±0.2103D、Log Mar-0.123±0.115、Log Mar0.025±0.066,與6個(gè)月時(shí)差異均無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論:1.SMILE和FS-LASIK術(shù)后1周角膜厚度降低最明顯,FS-LASIK組為著,3個(gè)月均輕度增厚,6個(gè)月時(shí),SMILE中心區(qū)、內(nèi)環(huán)區(qū)、外環(huán)區(qū)均基本穩(wěn)定,FS-LASIK中央?yún)^(qū)及外環(huán)區(qū)持續(xù)明顯增厚,可能與瓣膜有關(guān)。2.無(wú)論SMILE或FS-LASIK中央?yún)^(qū)厚度變化量與術(shù)前SE均相關(guān)。SMILE厚度的總體變化小于FS-LASIK,提示手術(shù)設(shè)計(jì)時(shí)nomogram調(diào)整。3.SMILE術(shù)后6個(gè)月至5年間不同區(qū)域角膜厚度有增厚,但與術(shù)后屈光度無(wú)相關(guān)。4.SMILE術(shù)后5年時(shí)等效球鏡度、裸眼視力、最佳矯正視力均保持穩(wěn)定,具有較好的穩(wěn)定性。
[Abstract]:AIM: To analyze the short-term changes of corneal thickness and refractive index after femtosecond laser assisted in situ keratomileusis (FS-LASIK) and small incision lenticle extraction (SMILE). Methods: A retrospective study was conducted in 86 patients who underwent refractive surgery in Tianjin Ophthalmological Hospital from June 2014 to January 2015. (148 eyes), 60 cases (104 eyes) in SMILE group and 26 cases (42 eyes) in FS-LASIK group. The thinnest corneal spot, central area (2 mm in diameter), inner area (2-5 mm in diameter) and outer area (5-6 mm in diameter) were measured before operation, 1 day, 1 week, 1 month, 3 months and 6 months after operation, respectively. 8 cases (16 eyes) with myopia and astigmatism underwent SMILE from August 2011 to March 2012 in the Refractive Surgery Center of Tianjin Ophthalmological Hospital. The corneal thinnest point (0 mm) and the thinnest point (2 mm, 4 mm, 6 mm, 8 mm) were measured before surgery, 1 day, 1 week, 1 month, 3 months, 6 months and 5 years after surgery. The cornea was divided into five areas with a diameter of 2 mm, 2-4 mm, 4-6 mm, 6-8 mm and 8-10 mm. The corneal thickness was the thinnest point before operation - the intraoperative resection lens thickness = the theoretical corneal thickness, the thinnest point corneal thickness - the theoretical corneal thickness = the deviation of corneal thickness (delta'CT). The corneal thickness of the area was the same at different time after operation - the same at 1 day after operation. Regional corneal thickness = the change of regional corneal thickness (delta CT) at that time. Statistical methods: Corneal thickness, spherical equivalent (SE) and best corrected visual acuity (BCVA) were compared between SMILE and FS-LASIK groups using two-factor analysis of variance of repetitive measures, and single-factor analysis of repetitive measures within the group. Results: 1. Corneal thickness was thinner after SMILE and FS-LASIK, and thinner at 1 week than at 1 day in both groups (SMILE: P < 0.002; FS-LASIK: P < 0.001), and greater in FS-LASIK group (p 0.001). At 2 and 6 months, there was no difference among the three regions of SMILE (p0.05). There was no difference between the three regions of FS-LASIK and that at 3 months (p0.05). Corneal thickness increased linearly in the central and outer regions, and in the outer ring regions (p = 0.023, 0.001). 3 days, 1 week, 1 month, 3 months and 6 months after operation. The degree deviation of SMILE group was 20.06+6.75, 15.42+8.84, 15.42+6.84, 17.21+8.02, 17.21+8.02, 24.42+8.68, 24.42+8.68, 24.81+8.64, SMILE group was 20.06 +6.75, 15.42 +6.75, 15.42 +6.84, 15.42 +8.84, 17.21 +8.02, 24.42 +8.48, 24.42 +8.68, 24.81 +8.68, 24.81 +8.64, SMILE group was - 1.57 +13.61, 14.88.61, 14.88 [-14.88 [-88 [-7.88 F cross = 13.873, P 0.001).4, SMILE After SMILE and FS-LASIK, the thickness of the thinnest cornea was 7.56, 7.69, 8.50, 7.88 and 6.25 microns respectively thicker than that at 6 months. 5 years after SMILE, the equivalent sphericity, naked eye vision, best corrected visual acuity were - 0.1016 + 0.2103D, Log Mar - 0.123 + 0.115, Log Mar 0.025 + 0.066, respectively. There was no significant difference between 6 months after SMILE and FS-LASIK (p 0.05). Conclusion: 1. In the ASIK group, the central, inner and outer zones of SMILE were stable at 6 months. The central and outer zones of FS-LASIK were significantly thickened, which may be related to the valve. 2. The changes of central zone thickness of SMILE or FS-LASIK were correlated with preoperative SE. Nomogram adjustment. 3. Corneal thickness in different areas increased between 6 months and 5 years after SMILE, but not related to postoperative diopter. 4. Equivalent sphericity, naked eye vision and best corrected visual acuity remained stable at 5 years after SMILE.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6

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